Reduce Burnout in Palliative Care Teams with Mindfulness
By John M. de Castro, Ph.D.
“The fullness of life, tuned-in “being” and focused work that result from mindfulness have significant health and well-being consequences for hospice and palliative care professionals.” – Ellen Langer
Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. It is estimated that over 45% of healthcare workers experience burnout. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion, sometimes called compassion-fatigue. This can be particularly problematic in a palliative care setting where empathy and compassion are critical.
Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning out has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. Another factor that could affect healthcare workers’ responses to stress is self-compassion. By treating oneself with kindness and understanding the effects of stress can be mitigated. So, it makes sense to investigate the relationship of mindfulness and self-compassion to compassion-fatigue and burnout in palliative care workers.
In today’s Research News article “Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501358/, Orellana-Rios and colleagues recruited staff members of a palliative care facility and provided for them a 10-week program of mindfulness training that was incorporated into their daily job duties. The training included discussions, loving kindness meditation, walking meditation and tong-len meditation. They were also encouraged and provided materials (CDs) for home practice. Participants were measured before and after treatment for burnout, anxiety, depression, somatization, emotion regulation, work satisfaction and enjoyment, and goal attainment. They also provided saliva samples for measurement of cortisol levels. After completion of the study, the participants were interviewed concerning the effectiveness of the program.
They found that following the training there was a significant decrease in burnout, perceived stress, and anxiety and a significant increase in emotional awareness, resilience, joy, goal attainment, and enjoyment of work. In the interviews, the participants generally reported improvements in feeling empowered to take care of themselves, including mindful pauses throughout their day, and lower levels of worry and rumination.
These are interesting and potentially significant preliminary results. This should be considered as a pilot study as there was no control or comparison condition included. The participants’ measurements before training were simply compared to those after training and there were no long-term follow-up measurements. But, the results are sufficiently interesting to justify the conduct of a large-scale randomized controlled clinical trial including an active control and long-term follow-up.
Taken together with previous research that has demonstrated that mindfulness training decreases burnout, anxiety, depression, and increases emotion regulation and resilience, the results suggest that mindfulness training is highly beneficial for the improvement of the emotional well-being of staff involved in palliative care. Although not measured, this suggests that staff turnover and importantly, the care for the patients was also improved.
So, reduce burnout in palliative care teams with mindfulness.
“in the end, talking to patients about palliative care can make a huge difference in their lives. It can restore their dignity and empower them to live the remainder of their lives on their own terms. And that’s why palliative care, which promotes quality of life through mindfulness, creativity, and compassion, is gaining widespread acceptance.” – Anne Bruce
CMCS – Center for Mindfulness and Contemplative Studies
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Orellana-Rios, C. L., Radbruch, L., Kern, M., Regel, Y. U., Anton, A., Sinclair, S., & Schmidt, S. (2018). Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program. BMC Palliative Care, 17, 3. http://doi.org/10.1186/s12904-017-0219-7
Maintaining a sense of self-care while providing patient centered care, can be difficult for practitioners in palliative medicine. We aimed to pilot an “on the job” mindfulness and compassion-oriented meditation training for interdisciplinary teams designed to reduce distress, foster resilience and strengthen a prosocial motivation in the clinical encounter.
Our objective was to explore the feasibility and effectiveness of this newly developed training. The study design was an observational, mixed-method pilot evaluation, with qualitative data, self-report data, as well as objective data (cortisol) measured before and after the program.
Twenty-eight staff members of an interdisciplinary palliative care team participated in the 10-week training conducted at their workplace.
Measures were the Perceived Stress Questionnaire, the Maslach Burnout Inventory, the somatic complaints subscale of the SCL-90-R, the Emotion Regulation Skills Questionnaire, the Hospital Anxiety and Depression Scale, and a Goal Attainment Scale that assessed two individual goals. Semi-structured interviews were employed to gain insight into the perceived outcomes and potential mechanisms of action of the training. T-tests for dependent samples were employed to test for differences between baseline and post-intervention.
Significant improvements were found in two of three burnout components (emotional exhaustion and personal accomplishment), anxiety, stress, two emotional regulation competences and joy at work. Furthermore, 85% of the individual goals were attained. Compliance and acceptance rates were high and qualitative data revealed a perceived enhancement of self-care, the integration of mindful pauses in work routines, a reduction in rumination and distress generated in the patient contact as well as an enhancement of interpersonal connection skills. An improvement of team communication could also be identified.
Our findings suggest that the training may be a feasible, effective and practical way of reducing caregiver-distress and enhancing the resources of palliative care teams.